Today on the Doc On the Run Podcast we’re talking about how runners can get the very best second opinion.
This episode will explain pretty much everything you need to know about finding a second opinion doc in your area, but if you still have questions after you are done with this, look at the Virtual Doctor Visit at the bottom of this page.
The other day I had an interesting conversation with a runner who has had a really difficult time recovering. The bottom line is that she had a couple of surgeries that didn’t work out exactly the way she expected, and now she is still having trouble.
So we were having a conversation about how she can make sure her current treatment plan is the best plan to get her back to running. We talked about all different kinds of surgical options, different treatment approaches and how the doctor’s decision making process works. And through the course of that conversation I realized that many runners just don’t understand how they should approach a doctor when they are getting a second opinion.
Your goal when you are getting a second opinion is to make sure you are getting an unbiased perspective on where you are right now and where you want to end up.
Let me repeat that…
Your goal when you are getting a second opinion is to make sure you are getting an unbiased perspective on where you are right now and where you want to end up.
Every doctor is an expert. Every doctor has many years of training. Between college, medical school and surgical residency, I spent 13 years in higher education after I finished high school. But that’s not really unique. All doctors have many years of training and in that respect all doctors are experts in their field.
The problem when a runner goes for a second opinion is not that they aren’t getting the right expert. The problem is that you, as an injured runner just don’t really always know the best way to extract that expertise you need from the doctor.
So I’m going help you understand some of the biggest mistakes runners make when they approach a doctor for a second opinion.
We all know it sucks when you’re injured. But you can’t just keep staring at the injury. You can’t keep focusing on the problem. You have to focus on the goal.
You’re never going to go to your coach and say, “I’m fat and slow. Can you make that better?”
Your coach would demand a better goal. Your coach wants to know something more along the lines of “I would like to run a marathon in 3 hours and 25 minutes” or “I’d like to run a 5K in under 30 minutes”. Those are goals your coach can work with.
Interestingly when runners go to the doctor, they start talking about problems instead of goals.
That’s not really your fault. The doctors design their questionnaires to focus on pain, disability, and limitations of activity. What’s the nature of your pain? How long you been in pain? Is your pain tingling, radiating, burning, sharp, dull, or throbbing? All kinds of detail about problems.
There is almost no chance you are going to go to standard doctor and see questions like, “How fast do you want to run? How many days a week do you want to run? How many miles a week do you want to run?”
Those sort of goals are just not on the radar for most doctors.
So rule number one is put your goal on the doctor’s radar. Don’t talk about your pain. Talk about who you are as an athlete. Talk about your athletic goals.
“I am here today because I want to qualify for the Boston Marathon.” That’s the headline.
The subtitle of course can be. “…and my foot hurts, which is interfering with my training for my next marathon, where I hope to qualify for the Boston Marathon.”
You have to set the stage correctly if you want to get this show going in the right direction.
Believe it or not, not every doctor has the same sort of training. Some surgical residencies only focus on elective surgeries and get no trauma experience at all. Some surgical residencies may have very limited experience with certain kinds of fractures. Even if you don’t understand exactly what that means, it’s not important.
What is important is that you realize that doctors with different training and different experiences will have different perspectives. A different perspective will often let them look at a problem differently.
If you’ve got an opinion that you don’t like, or you got a treatment plan and it’s not helping you get better, you definitely need a different perspective. You need someone to look at that problem differently and try to come up with a different solution that will get you back to running.
I am a podiatric surgeon with high level surgical training. I’ve done a broad range of surgeries. I have worked with lots of different specialists. But almost all of my experiences are related to feet and ankles. Yes, I did do a comprehensive surgical residency and I did do surgeries that weren’t related to feet and ankles.
I scrubbed in on carotid endarterectomy surgeries where we cut the blood clots out of peoples carotid arteries in their necks. I did hemorrhoid surgeries. I did total joint replacements like knees and hips. I did carpal tunnel releases and even breast reductions. But I have done thousands of foot surgery procedures and only a handful of all those other things.
An orthopedic surgeon has a broader range of surgical experience than I do. That’s because they work on all different types of bones. They work on all different types of musculoskeletal ailments. And it’s because their training is different.
When I was in residency there was an article published in a prominent medical journal which basically stated that most orthopedic surgery residencies only have a couple of weeks of dedicated foot and ankle experience. So you could argue that I have way more foot and ankle surgery experience than most orthopedic surgeons. That doesn’t make my experience better, just different.
But that’s not all the point here. The main point is that when you go see an orthopedic surgeon and you either disagree, feel uneasy or just plain don’t like the plan you were given, you have to seek a different opinion. If you go see another orthopedic surgeon in the same area, the chances are really good you’re going to get the same decision making process.
Instead you may be better off getting a second opinion from a podiatric surgeon who specializes in feet and ankles. Better yet, you could see a sports medicine specific podiatric surgeon.
A completely different approach would be to find an osteopathic physician who does sports medicine but is not surgically trained. And that point is extremely important.
A few years ago I was considering having surgery. It wasn’t running related thing but in short, I was going to have surgery on my throat. So of course I knew what I should do to get consultations with the most reputable doctors in my area.
The first surgeon I saw was the most respected head and neck surgeon at one of the hospitals where I had surgical privileges myself. I had seen him in the surgical staff meetings many times. He seemed to be qualified, thoughtful and well-trained and he had the right credentials and all that sort of stuff.
But the truth is I couldn’t stand that guy. He didn’t listen to a single thing I said. He seemed to be stuck on this idea of giving me allergy shots every week for a year or more. When I tried to redirect the conversation back to the specific surgical procedure that we were originally discussing, he was overly conservative. I just didn’t believe he was going to help solve the problem.
Next I went to see a surgeon at Stanford University and I liked his approach better and I liked his proposed surgical option better than the first guy.
But what was most valuable was the third opinion I got. I actually found a doctor who was semi-retired. He had been the Chief of Head and Neck Surgery for almost 30 years in a hospital in the Philippines. After he came to San Francisco, he continued to do head and neck surgery. After decades of practice he finally stopped doing surgery but he still had a practice where he worked a couple of days a week. Yet he was no longer operating on people. So he basically had a nonsurgical practice.
Now you maybe wondering why I would see a non-surgical guy like that for a second opinion when I knew I needed surgery. Here’s the best part, he had absolutely nothing to gain by recommending any particular surgical procedure. We both knew he would not be doing my surgery. But, he had almost 50 years of surgical experience. So he patiently and clearly explained all of the differences between the other two doctors, and the two different surgical approaches. After that consultation I had a crystal clear vision of what needed to happen.
So that’s rule number two, try to find a doctor who can give you a second opinion that doesn’t have any skin in the game. Find somebody who can give you a clear perspective without trying to talk you into letting them do your surgery.
If an orthopedic surgeon tells you have to have surgery then you may want to see someone who is not going to operate on you either because they just don’t do surgery or they have a completely nonsurgical practice, or they’re located somewhere far enough away from you that it’s impractical they would perform your surgery.
Whenever possible, you want to try to remove any conflict of interest. You don’t want a doctor trying to talk to you into having surgery, if they’re going to benefit from that surgery financially.
This happens all the time so if you’re listening to this and you are thinking about reaching out to me for a second opinion, do not send all the details about what all the doctors had told you. It decreases the value of your consultation.
Let me explain what I mean by that. If you are sitting at home or you’re at the gym, I want you to try this exercise. But don’t do it if you’re driving.
Close your eyes, but do not picture a purple elephant. What did you just see? Did you see a purple elephant? Why did you do that? I mean, I did just tell you not to picture a purple elephant, right?
Whether you know it or not most doctors spend years learning shortcuts and one of the fastest shortcuts is to figure out what another doctor already thinks.
You’ve probably seen this in the past. You go see a doctor and you’re told to get an x-ray and an MRI. Your doctor then tells you what’s in the “radiologist report.”
The radiologist is another doctor who specializes in reading x-rays, MRI and CT scans. When you have one of these imaging studies the radiologist will sit in a dark room somewhere, perhaps in your hometown, but the radiologist could actually be a contracted radiologist in India, and wherever that doctor is she will read your x-rays.
But she doesn’t know what’s wrong with you. She doesn’t know your story. She hasn’t talked to you. She hasn’t heard your running history and she certainly hasn’t look to your foot. All that radiologist is looking at are your images when she’s sitting in that dark room somewhere halfway around the world.
After she takes a look at your films she will dictate a radiology report that outlines her findings. And she’ll then fax that completed X-ray report to your doctor. Your doctor pulls it out of the fax machine and then tells you what he “sees” in the report.
I always look at the films with my patients. If you send your images to me as an electronic file, I actually load them into an image viewing program. I look at them myself and I make a PDF of relevant images and then I send those back to you so that we can discuss them during your second opinion consultation. And that’s exactly what your doctor should be doing with you.
If your doctor tells you what’s in the report but doesn’t actually show you the images and go through them with you, the chances are really good that your doctor never actually looked at the images himself.
In that case if the radiologist says you don’t have a stress fracture, then your doctor probably has to look for something else as a cause for your pain.
The reason I’m explaining this to you is that you have to understand that when you go to get a second opinion, you do not want the doctor to look for the problem some other doctor diagnosed you with.
If your previous doctor told you had a stress fracture and you’re not getting better, you might have a different problem. But if you go to see a second doctor for second opinion you say “I’m here because my stress fracture isn’t getting better” then the second opinion doctor is almost certainly going to just start looking for ways to heal your stress fracture faster, rather than actually looking for a different cause of your problem altogether.
Again, it’s very difficult to not see that purple elephant.
And that brings us back to the runner I mentioned at the beginning of this discussion. I wasn’t actually her second opinion. I was her fifth or sixth opinion.
She’s finally gotten to a point where it seems like she has a good plan. But given all the trouble she’s had with a couple surgeries that didn’t go exactly the way she wanted, she understandably wants to be absolutely certain she’s on the right path.
She asked me, “Who else should I see for another opinion just to confirm this plan makes sense?”
I thought about that for a moment and I said “Look, here’s what you should do.” I gave her the name of the doctor I know personally. This is someone I’ve operated with many times. I believe she’s smarter than me. I think she’s thoughtful, she’s also runner and in addition she’s very likable and empathetic.
So I explained, “You should go see this doctor. But do not tell her what the problem is. Do not tell her you saw me. Do not tell her what surgery I think you should have to fix it and when she looks at your foot and sees the scars on your foot, do not tell her who did your previous surgeries.”
Instead what I think would be most helpful is if she just goes to see the doctor and says “Look I had surgery and this is what I feel when I walk. And this is what I need to get it to improve to the point where I can run.”
Remember, when you go to get a second opinion, you’re not going to see the doctor to figure out what’s wrong. You are trying to figure out how to run. Make sure that you get different opinions and make sure that you direct that discussion towards getting back to running as quickly as possible!
Still have questions? Not sure whether or not you can run again? Well you can get real answers in less time than it takes to drive to the doctor’s office with the Virtual Doctor Visit. I provide remote consultations for athletes all over the world where I give out real expert advice and personalized consultations via telephone and Skype. This is for runners who really want to keep running and need to know exactly what to do.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!
Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.
But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.
You can arrange a Virtual Doctor Visit with a true expert on running injuries. Right from the comfort of your own home you can meet online with the doctor, discuss your running history, talk about your running injury and figure out a customized recovery plan that will help you heal the running injury so you can get back to running as quickly as possible.
Book your Virtual Doctor Visit with Doc On The Run now!